Magnetic Resonance Can Reduce the Need for Prostate Biopsies

Methodology and Study Progress

In a prospective cohort of 191 men with elevated PSA levels, the authors compared the results of 3T MRI and subsequent transrectal biopsy. On 3T MRI, they assessed T2-weighted images, diffusion-weighted images, MRI spectroscopy, and pharmacokinetic data after the administration of contrast agent. They calculated blood volume and transfer constant. The diagnosis of prostate cancer was confirmed if ≥ 3 MRI signs were positive: T2 hypointense lesion, diffusion restriction, increased choline/creatinine peak on the spectrum, and malignant-type saturation of the contrast agent. Biopsies were evaluated by qualified uropathology experts.

Results

Biopsy was performed on 164 patients because in 27 of the enrolled men, the probability of cancer based on MRI results was minimal to none. 84 cases of prostate cancer were detected. Comparison of MRI results with biopsy results showed a sensitivity of 97.6%, specificity of 85.0%, positive predictive value of 74.6%, and negative predictive value of 96.3%. Only 3 false-negative cases were identified using 3T MRI, and 3 patients with highly suspicious findings on 3T MRI had biopsies that did not confirm cancer.

Conclusion

The authors from the University Hospital in Plzeň concluded that routine examination of patients with elevated PSA using 3T MRI can reduce the number of necessary transrectal biopsies in men with elevated PSA and improve tumor detection due to more targeted biopsies.

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Source: Ferda J., Kastner J., Hora M. et al. A role of multifactorial evaluation of prostatic 3T MRI in patients with elevated prostatic-specific antigen levels: prospective comparison with ultrasound-guided transrectal biopsy. Anticancer Res 2013; 33 (6): 2791−2795.